Advanced colonic neoplasia in the first degree relatives of colon cancer patients: A colonoscopy‐based study

Abstract

We aimed to determine the risk of advanced neoplasms among a cohort of asymptomatic first degree relatives (FDRs) of patients with sporadic colorectal cancer (CRC) compared with matched controls. Data for patients with a diagnosis of CRC made between September 2013 and August 2014 were obtained from a population-based cancer registry system in Tehran. Screening colonoscopies were done for 342 FDRs and the findings were compared to those from 342 age- and gender-matched healthy controls without a family history of CRC. We reported the association as conditional Odds Ratio (OR) using Mantel Hazel and Logistic regression. The prevalence of advanced neoplasia was 13.2% among FDRs and 3.8% in controls (matched OR [mOR], 4.0, 95% confidence interval [CI], 2.1 - 7.6; p < 0.001). In FDRs aged 40-49 years, the prevalence of advanced neoplasia was significantly higher than in their matched controls (mOR, 6.8, 95% CI, 1.5-31.4; p = 0.01). Family history of CRC in at least one FDR was the strongest predictor of advanced neoplasia (adjusted OR, 4.0, 95% CI: 2.1-7.6; p < 0.001). The age of the index case at diagnosis did not predict the presence of advanced colonic neoplasms in their FDRs. Our study indicates a high risk of advanced neoplasia in FDRs of CRC cases, where only eight colonoscopies are needed to detect one advanced neoplasia. Our data suggest that all FDRs, regardless of the age of CRC diagnosis in their index case, should be considered for a targeted early screening.

Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer

“…Population-based studies and randomized trials suggest that adherence to use of colonoscopy for screening in average and increased-risk populations is usually suboptimal . This undermines the efficacy of screening programs and underlines the need for alternative screening modalities that may limit the need for colonoscopy only to those participants with positive results. Several recently published guidelines support the use of FIT for screening of average-risk participants .…”

Lower Relative Contribution of Positive Family History to Colorectal Cancer Risk with Increasing Age: A Systematic Review and Meta-Analysis of 9.28 Million Individuals

“…In our meta‐analysis, 13 out of 63 studies showed no significantly increased risk of CRC among individuals with family history of CRC [28, 39, 40, 42, 43, 56, 58, 59, 66, 72, 73, 79, 80], compared with other 50 studies that reported increased relative risk. Some possible explanations for this difference include the accuracy of self‐reported family history, varying quality of colonoscopy and experience of endoscopists across studies, the number of risk factors of CRC among subjects included in these studies, and differences in their region of residence.…”

“…The full texts of the remaining 812 articles were reviewed, with 45 articles fulfilling our eligibility criteria being selected, and 18 additional studies selected from reference lists of eligible articles. Therefore, a total of 63 articles were included in this meta‐analysis, including 9,284,074 patients (Supplementary Table 2 ) [242526272829303132333435363738394041424344454647484950515253545556575859606162636465666768697071727374757677787980818283848586]. The earliest calendar year of subject enrollment was 1982.…”

Colorectal Cancer: Epidemiology, Risk Factors, and Prevention

“…In addition, considering risk stratification to identify high-risk individuals was suggested to increase the effectiveness of CRC screening programs. Different risk factors, including age, gender, smoking, and family history, may be considered for the calculation of risk scores [229][230][231][232]. Combining the risk score with the FIT test was suggested as an effective strategy for more accurate detection of colorectal neoplasia in asymptomatic individuals [233][234][235].…”